| NPI | 1386298628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AL LPC04543) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: AL C3340A) |
| Enumeration Date | 2019-07-25 |
| Last Update Date | 2023-09-06 |